Staphylococcus saprophyticus as a cause of urinary tract infections

Our objectives in this study were to elucidate various aspects of the epidemiology of Staphylococcus saprophyticus. This organism was isolated from the midstream urine specimens of 7.5% of 145 college women with frequency and urgency of urination and dysuria, but from only 0.07% of 14,835 urine specimens from adult inpatients at the Victoria General Hospital. It was found to be part of the urethral flora of only 2% of healthy women. Other staphylococci which formed part of the urethral flora of 100 healthy women included S. epidermidis (59 women), S. hominis (15 women), S. haemolyticus (13 women), S. warneri (9 women), and S. aureus (6 women). Finally, we determined that resistance to the 5-micrograms novobiocin disk has a 93% positive predictive accuracy as a presumptive test for S. saprophyticus.

Serratia marcescens-a marker for an infection control program

An infection control program was instituted at The Victoria General Hospital, an 800-bed acute care hospital, in July 1977. Serratia marcescens had infected or colonized (I/c) 225 to 232 patients yearly for each of the three previous years. Since this organism is usually acquired nosocomially, we decided to use Serratia I/C as a marker for our infection control program. During the years 1977 to 1980, we identified and eliminated several reservoirs of Serratia (contaminated urine measuring containers, urometers, diabetic urine testing equipment and in-use contamination of 2% Hibitane). Readmission of previously I/C patients proved to be an increasingly important reservoir. During 1980, only 120 patients were I/C, and gentamicin-resistant isolates of S.marcescens had dropped from 44% in 1977 to 4.4% in 1980. Use of Serratia as a marker enabled us to monitor the efficacy of our infection control program and allowed us to prove to our health care workers the usefulness of many of the measures we introduced.

Nutritional modulation of immune responses

Malnutrition has been linked in field studies with increased susceptibility to infection, often associated with severe marasmus or kwashiorkor. However, studies by Jose and colleagues revealed an apparent paradox: while B-cell immunity was decreased by chronic moderate malnutrition, several aspects of T-cell immunity were enhanced. In extensive experimental studies we have analyzed the effects of dietary restriction in immunologic function and development of disease. Our investigations may be grouped into three related areas. 1) Differential effects of protein or protein-calorie malnutrition on B-cell and T-cell immunity. While antibody-mediated immunity was impaired in animals moderately restricted with respect to protein or total calories, several T-cell functions were consistently enhanced in mice, rats, guinea pigs, and monkeys. 2) Influence of restricting a single nutritional element, the trace metal zinc, on immunologic function. Zinc deficiency produces progressive thymic involution and a progressive loss of T-cell immunity functions in mice and rats. While congenital failure to absorb this element normally is the single cause of hereditary acrodermatitis enteropathica, a frequently lethal disease both in humans and in cattle, acrodermatitis enteropathica has also been linked with common variable immunodeficiency disease, total parenteral alimentation with preparations lacking zinc, several forms of cancer, marasmus, and kwashiorkor. 3) Inhibition by dietary restriction of development of the diseases of aging. Disorganization of thymus-derived immunity, and development with aging of genetically determined diseases in several strains of mice, can be sharply curtailed or even prevented by reducing the intake of total calories or fat. Similarly, development of mammary cancer in C3H female mice is prevented by restricting dietary intake of fat.

Actinobacillus actinomycetemcomitans endocarditis

Two patients had infective endocarditis due to Actinobacillus actinomycetemcomitans. One, a 52-year-old woman with a prosthetic aortic valve, was successfully treated with carbenicillin and gentamicin. The other, a 47-year old man with calcific aortic valve disease, required emergency valvectomy and prosthetic valve replacement and responded to a combination of penicillin and gentamicin.

The quality of railway carriage environments

A questionnaire was developed for use with a large sample of passengers travelling in British Rail stock on a cross-section of main line routes serviced by London Midland Region. The questionnaire was distributed to a stratified random sample of 1500 passengers-covering both male and female travellers in five different carriage types. The aim of the study was to determine the improvements passengers would most like to see in existing carriage design, and generally what they felt about the quality of their environment. The questionnaire included sections covering personal and travel details, a check list of conceivable improvements, and the use of the semantic differential technique for obtaining passengers' impressions and perceptions. The findings allowed comparisons to be made between the different carriage interiors and resulted in recommendations for the possible modification of certain carriage designs.

Concurrent schizophrenia-like psychosis in monozygous twins suffering from CNS disorder

Twin studies and investigations into the relationship between schizophrenia-like psychosis and cerebral dysfunction are of considerable interest. Refinement in twin studies has led to less emphasis being placed upon the genetic factor, but the pitfalls surrounding twin techniques, especially with regard to monozygous pairs and the similarity of their environment, have led Penrose (1971) to the opinion that twin study ‘is especially useful, not for genetical researches but in assessing the effects of environmental influences which lead to discordance in identical twin pairs'.